IMAGING & ONCOLOGY - Society of Radiographers

68Clinical oncologistsThe National Radiotherapy Advisory Group report has stated that a signifi cantproportion of routine work could be delivered by appropriately trained non-medicaladvanced/consultant practitioners who have the necessary knowledge and skills 1 .This will free consultant medical staff to focus on the remaining more complex clinicalwork such as developing the IMRT service. Continuing the development of a structureto support this (eg implementing the Career Progression Framework, formerly knownas the four tier structure, in therapeutic radiography) is vital to its success. A numberof work streams are taking place that will infl uence the development of the workforcemodel.Developing solutionsWe have already begun to publish some of the learning from the four tier pilot sites.This has begun with the Society and College of Radiographers’ document ‘Policyinto Practice’ 2 . There are already a number of tools for the assistant practitioner role,and more encouragement and direction, along with better signposting to servicesmanagers from the professional bodies to support their wider uptake, will be helpful.Whilst local fora exist for discussion with those commissioning and providing educationand training for the radiotherapy workforce, little opportunity exists nationally toexplore solutions and share thinking. The National Cancer Action Team has thereforebegun a series of national workshops to develop this engagement. We have made acommitment to continue this into the future.The fi rst workshops began with Higher Education Institution (HEI) leads and managersfrom the four tier pilot sites. These were successful and gave a number of structuredactions for development. A further workshop in March this year was open to allradiotherapy managers, all HEI leads along with invites to SHA workforce and cancerleads. The focus of the meeting was on the (newly) qualifi ed workforce and howto maximise the development of this vital resource. At the time of writing, earlyindications suggest this was a most productive and innovative forum.programme or qualifi cation. This leads to two problems: Firstly that mobility of theworkforce is limited. If you are unable to demonstrate a level of learning, a newemployer will be uncertain of your competencies and therefore of the level of yourability. Secondly, recruitment into a profession that is not recognised through astructured training route or qualifi cation will remain a challenge.In response, we have developed a national dosimetry early implementation trainingprogramme. With an intake planned for spring 2010, this will work with a smallnumber of radiotherapy physics services in the early implementation phase to developthe curriculum and the education process. It is anticipated that this will become theplatform for a long overdue national training programme.Staffing modelsLooking at skills mix in its wider context is part of the strategic vision. Defi ningskills mix in terms of whole time equivalent staff within each professional group(however well intentioned) leads to silo working and limited service development.If we consider our overall staffi ng resource to be set as a fi xed number in eachprofessional group (three of this group, two of that and one of these); role expansionand development is constrained as established posts and budgets are now fi xed.Instead, we should consider the workforce requirement as a whole, and based aroundcompetencies rather than job roles. This enhanced fl exibility will be vital as we moveforwards.With current staffi ng guidance limited to individual professional groups, the focusbecomes achieving the number rather than delivering the task. Cases for increasedresources then focus on appointing posts rather than the benefi t to the care pathway.Forward thinking services should consider their staffi ng resource as a single entity.Within this, there will always be a number of tasks that can only be undertakenby oncologist/physicist/radiographer, but many tasks are much broader and manyprofessionals are equally well-equipped to undertake them; we should be looking forthe best placed person at that time.2010IMAGING &ONCOLOGYWithin radiotherapy physics, ‘Modernising Scientifi c Careers’ (the new careerframework for the profession) was developed during 2009. Our intention was tohold back work with radiotherapy physics during this process to avoid mismatch ofprogrammes. We are now clearer on the direction of Modernising Scientifi c Careersand have therefore been able to begin; and 2010 will see the leading of this workwith radiotherapy physics in the same way as with the therapeutic radiographers.During 2010, we expect to begin to integrate these scientifi c and radiographicgroups. The solutions to our workforce issues and clinical delivery do not rest withinprofessional boundaries – but work across them.Dosimetrists are a key element of our workforce, especially as we develop thenational IMRT programme. We recognise that there is not a single national trainingWorking beyond boundaries extends to other areas too. Appropriate use ofadministrative staff to undertake admin duties has two benefi ts. Firstly they area more cost-effective resource, but secondly (and arguably more importantly)administrative tasks are a skill best left to those who are trained to do them sincethey are likely to do them more effi ciently and more effectively. In turn, this gives ourclinical workforce greater capacity for clinical delivery – sounds sensible and yet rarelyis this carried out to its full effect.Tough times aheadAs the NHS enters arguably its worst fi nancial period during the coming months,negotiating for a fi xed staffi ng establishment will be increasingly diffi cult. Arguingfor investment in radiotherapy will require commissioners to (further) disinvest inother areas. The benefi ts of doing this must be not only clear, but also unequivocal.